The present invention relates to a total contact cast, particularly of the type used to treat wounds often encountered by diabetic patients. A total contact cast is designed to redistribute plantar pressures and reduce shock and shear forces that contribute to tissue breakdown and that interfere with the normal healing process of open plantar ulcers on the diabetic foot. The application of appropriate structures to reduce pressure on pedal wounds and alter a patient's gait to prevent injury or reinjury of the tissues requires the use of several types of devices and footwear during the course of healing. The healing and post-healing stages are both important in the overall treatment sequence since treatment must include not only actual healing, but treatment after healing when newly healed tissues are thin, fragile and subject to being reinjured. Ideally, a proper treatment procedure should not only heal the wound but also protect delicate, recently healed tissues from further breakdown during the wound maturation process.
Some practitioners are reluctant to use a total contact cast. Reasons may include inadequate training, a lack of confidence to administer the treatment, a wound caused or made worse when using the treatment, or poor compliance demonstrated by diabetic neuropathic patients. The practitioner must trust a patient to follow the treatment protocol. A patient who has a demonstrated history of poor judgment in managing his or her care, with the restrictions imposed by prior art total contact casts has reduced the use of total contact casts in the past.
In order for diabetic sores and wounds to heal, substantially all of the patient's weight must be removed from the sore or wound, many of which occur on the balls of the feet.
Most practitioners treating diabetic wounds use a number of alternative off-loading devices due to a perceived complexity of applying total contact casts, concern for complications reported in the literature, the cost of materials for the device, reimbursement concerns, and a fear that application of the total contact cast will take too much time. Alternative devices used by practitioners include a removable cast walker, non-removable cast walker, instant total contact cast, molded or double upright ankle foot orthosis with or without a patellar tendon-bearing addition, Charcot restraint orthopedic walkers, modified Carville healing sandal, football dressing, commercial off-loading shoes such as the half or wedge shoes or wound care shoe systems, standard post-operative shoe, and depth or custom-molded footwear.
Most practitioners choose between these devices based on their individual experience with a particular modality, clinical availability, patient preference, or insurance reimbursement. The most commonly employed device is the surgical shoe with or without internal shoe modifications despite relatively poor evidence for healing when compared to the total contact cast or the instant total contact cast.
The diabetic patient is a complicated and often frustrating entity to treat. Patience, persistence, and a commitment to the patient are required to achieve a satisfactory result. There is therefore a need for an application method and components that allow practitioners to apply an effective total contact cast without the worry of cast misapplication common to total contact kits presently on the market. An ideal resolution produces a suspended foot within a rigid external total contact limb-load cast capable of supporting even the heaviest patient. There is also a need for a total contact cast that can be applied by a single practitioner without assistance.